دانلود Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges

Abstract

Post-traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its for-mal  introduction  in  the  DSM-III  in  1980,  knowledge  has  grown  significantly  regarding  its  causes,  maintaining  mechanisms  and  treatments.  Despite  this  increased  understanding,  however,  the  actual  definition  of  the  disorder  remains  controversial.  The  DSM-5  and  ICD-11  define  the  disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations  that  arise  after  trauma  or  should  be  focused  more  specifically  on  trauma  memory  phenomena.  This  controversy  over  clarifying  the  phenotype  of  PTSD  has  limited  the  capacity  to  identify  biomarkers  and  specific  mechanisms  of  traumatic  stress.  This  review  provides  an  up-to-date  outline  of  the  current  definitions  of  PTSD,  its  known  prevalence  and  risk  factors,  the  main  models  to  explain  the  disorder,  and  evidence-supported treatments. A major conclusion is that, although trauma-focused cognitive behavior therapy is the best-validated treatment for  PTSD,  it  has  stagnated  over  recent  decades,  and  only  two-thirds  of  PTSD  patients  respond  adequately  to  this  intervention.  Moreover,  most  people  with  PTSD  do  not  access  evidence-based  treatment,  and  this  situation  is  much  worse  in  low-  and  middle-income  countries.  Identifying  processes  that  can  overcome  these  major  barriers  to  better  management  of  people  with  PTSD  remains  an  outstanding  challenge.